30 Jun Surgery for GERD May Improve Reflux But Risks Complications
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Maret-Ouda : This review is part of the BMJ series “Uncertainties pages”, where clinically relevant, but debated, medical questions are highlighted and discussed. The present study is assessing treatment of severe gastro-oesophageal reflux disease, where the current treatment options are medical (proton-pump inhibitors) or surgical (laparoscopic antireflux surgery). The clinical decision-making is often left to the clinician and local guidelines. We evaluated the existing literature to compare the two treatment options regarding reflux control, complications, future risk of oesophageal adenocarcinoma, health related quality of life, and cost effectiveness.
The main findings were that surgery might provide slightly better reflux control and health related quality of life, but is associated with higher risks of complications compared to medication. A possible preventive effect regarding oesophageal adenocarcinoma remains uncertain. Regarding cost effectiveness, medication seems more cost effective in the short term, but surgery might be more cost effective in the longer term. Since medication provides good treatment of severe gastro-oesophageal reflux disease, but with lower risks of complications, this remains the first line treatment option.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Maret-Ouda : Both antireflux surgery and medical treatment with proton-pump inhibitors provide good and sufficient long-term results for severe gastro-oesophageal reflux disease. However, there is a slightly higher risk of complications associated with antireflux surgery. Therefore, these patients should primarily be offered proton-pump inhibitors. If insufficient results are achieved after eight weeks of adequately dosed medical treatment, antireflux surgery should be considered a good treatment option. In young, physically fit patients with severe gastro-oesophageal reflux disease, where treatment is probable to be ongoing for a very long time, surgery is a possible first line treatment, which also seems to be more cost effective in a long term perspective.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Maret-Ouda :
First, due to the advances in surgical and postsurgical care, the absolute risk of death or other severe complications associated with antireflux surgery needs to be further evaluated.
Second, the long-term results of both treatments should be assessed, especially regarding long-term complications, such as oesophageal adenocarcinoma as well as cost-effectiveness in relation to reflux control.
Third, there are several endoscopic techniques currently being developed and studied, which need to be assessed and further evaluated, since these might potentially pose good treatment options for gastro-oesophageal reflux disease.